UNIVERSITY OF MANCHESTER REGISTRATION

PLEASE FILL IN THE DETAILS BELOW

In order to receive testing through the University of Manchester partnership we need to take some details from you. This will ensure we can process your test effectively and efficiently.

Please note: this service is only available to University of Manchester medical students who require health testing to take part in practical modules. We will be verifying eligibility for testing with the university.

PLEASE BRING ID TO YOUR APPOINTMENT

In order to receive your certification you will need to bring either your passport or driving license with you to your testing appointment so that we can verify your identity. Failure to do so will mean we cannot process your order.

First name*
Last name
Gender*
Email address*
Telephone number*
Date of Birth*
Post Code*
Preferred Appointment Date*
Choose your preferred appointment date and we'll contact you to confirm.
Preferred Time*
Choose the time that you would like your appointment to be.
Alternative Appointment Date
Choose your alternative appointment date in case your first choice is not available.
Alternative Time
Choose the time that you would like your appointment to be.
Privacy policy*
- I have read and accepted the privacy policy
Contact consent*
- I am happy for Your Sexual Health to contact me
University Consent*
- I am happy that my results will be shared with University of Manchester

UNIVERSITY OF MANCHESTER REGISTRATION

PLEASE FILL IN THE DETAILS BELOW

PLEASE BRING ID TO YOUR APPOINTMENT

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